I ask this in all sincerity, from a patient's perspective: what happens if the pt does not follow through on these things? I love my PCP more than words can say, and I don't want to get him in any trouble. That being said, for my own reasons, I will not submit to many of these tests/procedures. He knows this and, out of his concern for my wellbeing, is not happy about my "noncompliance" but he also knows that forcing the issue will result in my avoiding him for the issues I *DO* follow through on.

Your doctor will not be "dinged" as long as he has documented that he attempted to perform the measures mandated by the PQRI initiative. He's done his part. But there are measures of effectiveness of therapy upon which he or she is measured, so if you were to choose not to manage your blood pressure or diabetes (just as an example), you might contribute to your doctor's diminished quality rating and payments from Medicare. From the CMS website:

"If there are no more than three quality measures applicable to the services provided by the Eligible Professional (EP), then each measure must be reported for at least 80% of the cases in which the measure was reportable. If there are four or more quality measures applicable to the services provided by the EP, then at least three measures, selected by the EP, must be reported for at least 80% of the cases in which each measure was reportable. EPs are encouraged to report on as many quality measures as are applicable to the services provided. Reporting on as many applicable measures as is practical will increase the opportunities to reach the 80% successful reporting level."

Doesn't that sound like fun? All of that for an additional $1.12 (1.5%) on a $75 dollar office visit.

Thank you for answering my question regarding patient "noncompliance." Perhaps I am coming late to this party/realization, but not only do these "best practice" issues sound like a royal pain for the doctors, there can well be ramifications for patients in many ways. For instance, if I were my doctor, I wouldn't want to treat me! Regardless of concerns for my health and wellbeing, patients like me can diminish your quality rating, just for exercising our right to refuse treatment. If I were a doctor, I would think twice (at least) about dropping such patients from my caseload.

My PCP is fabulous. I'd hate to see his quality ratings suffer because people like me make our choices, but I also see that these rating issues have the potential to bully me as the patient (not my doc doing the bullying, you understand).

Where will this end? Will my insurance company say "get a mammogram or get off our plan?" "take statins or else?"

This is scary stuff from the patient's perspective too. But I suspect you knew that already. Thanks for keeping us well informed on this craziness.

About Me

Westby G. Fisher, MD, FACC is a board certified internist, cardiologist, and cardiac electrophysiologist (doctor specializing in heart rhythm disorders) practicing at NorthShore University HealthSystem in Evanston, IL, USA and is a Clinical Associate Professor of Medicine at University of Chicago's Pritzker School of Medicine. He entered the blog-o-sphere in November, 2005.
DISCLAIMER: The opinions expressed in this blog are strictly the those of the author(s) and should not be construed as the opinion(s) or policy(ies) of NorthShore University HealthSystem, nor recommendations for your care or anyone else's. Please seek professional guidance instead.